Music Therapy for Managing Dental Anxiety in Children: A Systematic Review and Meta-Analysis of Clinical Evidence

Abstract

Background: Dental anxiety is a common challenge in paediatric dentistry, often leading to avoidance of treatment and compromised oral health. Non-pharmacological interventions such as music therapy have gained increasing attention as safe and cost-effective alternatives to pharmacological approaches. Although several clinical studies have examined the impact of music on children's dental anxiety, the evidence has not yet been systematically summarised with quantitative synthesis. Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of music therapy in reducing dental anxiety and fear among paediatric patients. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library from inception to August 2025. Randomised controlled trials (RCTs) evaluating music therapy for dental anxiety in children were included. Primary outcomes were self-reported dental anxiety/fear scales and physiological measures (heart rate, blood pressure, oxygen saturation). Risk of bias was assessed using the revised Cochrane risk of bias tool (RoB 2, version 2019; Cochrane Collaboration, London, UK) Meta-analyses were performed using a random-effects model with Review Manager (RevMan, version 5.4; Cochrane Collaboration, London, UK). Results: Seven randomized controlled trials (RCTs) involving 476 children aged 4-14 years were included. Music therapy significantly reduced self-re-ported dental anxiety compared with control groups (SMD = -0.48, 95% CI: -0.72 to -0.25, p < 0.001). Heart rate was also significantly reduced (SMD = -0.42, 95% CI: -0.68 to -0.16, p = 0.002), whereas changes in blood pressure and oxygen saturation were not statistically significant. The overall risk of bias was moderate, with most concerns related to blinding. Conclusions: Music therapy is an effective non-pharmacological intervention to reduce dental anxiety in children, particularly improving subjective anxiety and physiological arousal as measured by heart rate. Its integration into paediatric dental practice may enhance cooperation and treatment outcomes, offering a safe, inexpensive, and child-friendly approach.

Keywords: behavior therapy; child; child cooperation; dental anxiety; meta-analysis as topic; music therapy; non-pharmacological interventions; pediatric dentistry; physiological stress markers; systematic reviews as topic.

Figure 1

PRISMA 2020 flow diagram of study selection [13].

Figure 2

Forest plot: Self-reported dental anxiety/fear. Each black square represents an individual study, with the size of the square proportional to its weight in the analysis. Horizontal lines indicate 95% confidence intervals. The blue diamond represents the overall pooled effect estimate, and the dashed vertical line marks the line of no effect (SMD = 0), where negative values favour music therapy. Included studies: Dixit & Jasani (2020) [16]; Janthasila & Keeratisiroj (2023) [17]; Chawla et al. (2025) [18]; Bayraktar & Akkoç (2024) [19]; and Singh et al. (2014) [21].

Figure 3

Forest plot: Heart rate (music vs. control; random effects). Each coloured square represents an individual study, with the size of the square proportional to its weight in the analysis. Horizontal lines indicate 95% confidence intervals. The black diamond shows the pooled effect estimate, and the dashed vertical line marks the line of no effect (SMD = 0), where negative values favour music therapy. Included studies: Alkahtani et al. (2020) [20]; Janthasila & Keeratisiroj (2023) [17]; and Bayraktar & Akkoç (2024) [19].

Figure 4

Forest plot: Blood pressure (systolic & diastolic combined Random-effects model). Each coloured line corresponds to a study outcome (SBP = systolic; DBP = diastolic). Squares represent study estimates with sizes proportional to their weights, horizontal lines denote 95% confidence intervals, the blue diamond indicates the pooled effect, and the dashed line marks the line of no effect (SMD = 0). Included studies: Dixit & Jasani (2020) [16] and Janthasila & Keeratisiroj (2023) [17].

Figure 5

Forest plot: Oxygen saturation (SpO2) Music vs. control. Black dots represent individual study estimates with 95% confidence intervals. The blue diamond indicates the pooled mean difference, and the dashed vertical line marks the line of no effect (SMD = 0), where positive values favour music therapy. Included studies: Janthasila & Keeratisiroj (2023) [17] and Bayraktar & Akkoç (2024) [19].